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Cystectomy – Neobladder Reconstruction Cystectomy – Neobladder

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Cystectomy – Neobladder Reconstruction Cystectomy – Neobladder CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER CYSTECTOMY – NEOBLADDER RECONSTRUCTION Location of Surgery: Saint John’s Health Center 2121 Santa Monica Blvd Valet parking available Hospital Phone: 310-829-5511 Patient Name: Date and Time of Surgery: Check-in Arrival Time (2 hours prior to surgery): Physician: Duration of Procedure: Approximate Total Time (arrival to discharge): Office Telephone: 310-582-7137 Office Fax: 310-582-7140 BE SURE TO ARRANGE FOR A FAMILY OR FRIEND TO DRIVE YOU HOME. IT IS RECOMMENDED THAT SOMEONE STAY WITH YOU FOR THE FIRST 24 HOURS AFTER THE PROCEDURE. John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 1 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER AFTER SURGERY APPOINTMENTS Radiology Appointment: You will have your pouchogram done at this appointment. • Date: • Time: • Location: Saint John’s Health Center 1st Floor 2121 Santa Monica Blvd Santa Monica, CA 90404 1-week Follow-up Appointment: Your urinary catheter will be removed at this visit. Take an antibiotic prior to appointment. • Date: • Time: • Location: Saint John’s Health Center Cancer Clinic (Garden Level) 2121 Santa Monica Blvd John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 2 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER GENERAL INFORMATION A radical cystectomy (bladder removal) is the standard treatment when cancer has spread into the muscle layer of the bladder or when earlier stage bladder cancer is not responsive to other therapies. It can also be done if there is severe bladder damage from treatments, conditions, or injuries. This surgery involves removal of the bladder, nearby lymph nodes, and part or all of the urethra. The surgeon will also remove the prostate and seminal vesicles in men, and the uterus, fallopian tubes, ovaries, and part of the vagina in women. Your surgeon may decide to perform this surgery using robotic assistance. Once the bladder is removed, it is then essential to create a different route to eliminate urine out of the body. This is called a urinary diversion. The most common types of urinary diversions are Ileal Conduit, Indiana Pouch, and Neobladder (Studer Pouch). Each urinary diversion requires special care and management. The normal urinary tract is made up of two kidneys which filter the blood and remove extra water and waste through the urine. The urine is eliminated by the kidney’s collecting system and travels down through the tubes, called ureters, into the bladder. Urine is stored in the urinary bladder until it is full and the person urinates. After the bladder is removed, the urine is diverted to exit the body through a urinary diversion. All forms of urinary diversion are made with a part of the body’s intestinal tract. In each type of urinary diversion, part of the intestine is turned into either a passage tube for urine to exit the body or a John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 3 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER reservoir (pouch) to store urine (like a normal bladder would). The surgery is done in such a way that urine and stool would remain completely separate as they would normally. For some patients, it is possible to safely connect a reservoir (pouch) made of small intestine to the urethra. This urinary diversion is made to function like a normal bladder. The patient is able to pass the urine through the urethra, although there is a period of incontinence (leakage of urine) that most patients go through following this surgery. It may take some patients up to one year to regain control of their urination. A few patients may not be able to empty urine from this reservoir well and will need to do catheterization (passing of a small tube into the urethra) to empty the reservoir. There must be no evidence of cancer spread to be considered for this sort of reservoir. Patients must be willing and able to pass a catheter (tube) into the urethra to empty the reservoir if necessary. ADVANTAGES of a Neobladder as Urinary Diversion • Most patients are able to empty their pouch by normal urination • No external bag is needed • No stoma • No activity restrictions DISADVANTAGES of a Neobladder as Urinary Diversion • Longer surgery time • Higher complication rate • Longer recovery period • Risk of urinary incontinence (urine leak) • Risk of inability to empty reservoir requiring catheterization at the scheduled times throughout the day John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 4 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER PRIOR TO SURGERY Pre-Operative Testing: • Pre-op clearance is needed to ensure your safety for surgery. • You will need to make an appointment with your primary care physician (PCP) within 1 month of your surgery date. o If you are over 60-years-old OR have cardiovascular, renal, or pulmonary issues OR if you have diabetes, you will be required to have an electrocardiogram (EKG). This can be done through your PCP or your cardiologist. If you have significant cardiac problems, you may require special clearance from your cardiologist. o If you have lung problems, you also may need a chest x-ray (CXR). o Orders will be sent for your necessary labs, CXR, and EKG. • If you do not have a PCP or cannot get an appointment in time, please call our office at (310) 582-7137. We can arrange for you to get clearance from our pre-op team here at Saint John’s. • All pre-operative testing must be completed with your results faxed to our office at least 1 week (no longer than 1 month) prior to your scheduled surgery. Illness: • If you develop a fever, signs of a cold, or any other illnesses between now and your surgery date, notify our office at (310) 582-7137. We likely will need to reschedule your procedure. 1 Week Prior to Surgery: Blood Thinner Medications to Stop: • Blood thinner medications can contribute to serious bleeding during or after your procedure. These common blood thinners should be evaluated by your managing physician, cardiologist, or PCP before surgery to ensure the safety of stopping these medications: o Coumadin (Warfarin) John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 5 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER o Plavix (Clopidogrel) o Eliquis (Apixaban) o Xarelto (Rivaroxaban) o Brilinta (Ticagrelor) o Effient (Prasugrel) o Ticlid (Ticlopidine) o There are other less common blood thinners that should be stopped as well (see comprehensive list) Over-the-Counter Medications or Supplements to Stop: • Stop taking these common over-the-counter medications and supplements 7 days before surgery (unless otherwise specified) as these may contribute to bleeding: o Aspirin . Check cold medication ingredients to make sure that it does not contain aspirin o All NSAIDS (e.g. Advil, Ibuprofen, Motrin, Naproxen) o Glucosamine o Chondroitin o Vitamin E • Herbal supplements and teas should be stopped 14 days before surgery to prevent bleeding (see comprehensive list) • It is okay to use Tylenol (normal or extra-strength) or previously prescribed narcotics with Tylenol (i.e. Percocet, Vicodin) for pain control days prior to your procedure, if necessary. • See the Comprehensive List of Medications to Stop on the next two pages. John Wayne Cancer Institute | Department of Urology and Urologic Oncology | Updated 5/6/20 | Page 6 CYSTECTOMY – NEOBLADDER RECONSTRUCTION CYSTECTOMY – NEOBLADDER Comprehensive List of Medications to Stop: The following medications contain nonsteroidal anti-inflammatory agents or aspirin ingredients that may interfere with the bloods’ ability to clot. These medications need to be stopped for at least a full 7 days prior to having your procedure. A.P.C. Cataflam Fiorina Methocarbamol Aceta-Gesic Celebrex Fiortal Micrainin Acuprin Celecoxib Flector Patch Midol Adprin-B Clinoril Flexaphen Midol Extended Relief Advil Co-Advil Flurbiprofen Midol Maximum Aggrenox Co-Gesic Four Way Cold Tablets Strength Cramp Aleve Congespirin Gelpirin tablets Formula Alka Seltzer Cope Gemnisyn Mobic Amigesic Coricidin Genpril Mobidin Anacin Damason-P Genprin Mobigesic Anaprox Darvon Compound Goody’s Body Pain Momentum Anaprox DS Daypro Goody’s Extra Mono-Gesic Anodynos DeWitt’s Pain Reliever Strength Headache Motrin Ansaid Diclofenac Halfprin 81 Motrin IB Argesic Diflunisal Halfprin MST 600 Artha-G Dipyridamole Haltran Nabumetone Arthritis Foundation Disalcid Healthprin Nalfon Pain Doan’s Heartline Naprelan Arthritis Pain Formula Dolene Ibuprofen (all Naprosyn Arthritis Strength Dolobid NSAIDs) Naproxen Bufferin Dolor Ibutab Night-Time Arthropan Doxaphene Indocin Effervescent Arthrotec Dristan Indomethacin Norgesic ASA Dristan Sinus Pain Ketoprofen Norgesic Forte Asacol Reliever Ketorolac Norwich Extra Ascriptin Durabac Levacet Strength Aspergum Duradyne Liquiprin Nuprin Aspirin Duraxin Lobac Nyquil Aspirin with codeine Easprin Lodine Nytol Asprimox EC-Naprosyn Lortab ASA Orphenadrine Azdone Ecotrin Magan Orphengesic Azulfidine Empirin Magnaprin Orudis Backache Maximum Empirin with codeine Magsal Oruvail Bayer Products Equagesic Marthritic Oxaprozin BC powder and tablets Equazine-M Meclofenamate Oxycodone and Bufferin Etodolac Meclomen aspirin Bufferin Arthritis Excedrin Medipren Pabalate-SF Strength Excedrin Aspirin Free Mefenamic Acid P-A-C Buffex Excedrin IB Meloxicam Painaid Butalbital Compound Extra Strength
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